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MRI in the Evaluation of Cryptogenic Stroke and Embolic Stroke of Undetermined Source

Jiayu Xiao1, Roy A Poblete1, Alexander Lerner1

  • 1From the Departments of Radiology (J.X., A.L., A.G.W., Z.F.), Neurology (R.A.P., P.L.N., N.S., P.D.L.), Physiology and Neuroscience (P.D.L.), Biomedical Engineering (Z.F.), and Radiation Oncology (Z.F.), University of Southern California, 2250 Alcazar St, CSC Room 104, Los Angeles, CA 90033; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (J.W.S.); Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, Calif (S.S.S.); Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, Calif (J.L.S.); Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland-Baltimore, Baltimore, Md (B.A.W.); and Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Md (B.A.W.).

Radiology
|April 23, 2024
PubMed

Insights

Cryptogenic stroke and embolic stroke of undetermined source (ESUS) lack clear causes. Advanced MRI techniques can help identify stroke origins and guide secondary prevention strategies.

Area of Science:

  • Neurology
  • Radiology
  • Cardiology

Background:

  • Cryptogenic stroke, a stroke of unknown cause, affects about 20% of ischemic stroke patients, often younger individuals.
  • Embolic stroke of undetermined source (ESUS) is a subtype of cryptogenic stroke where embolism is the suspected cause.
  • Current lack of confirmed etiology for cryptogenic stroke and ESUS leads to uncertainty in secondary prevention strategies.

Purpose of the Study:

  • To review the diagnostic value of various magnetic resonance imaging (MRI) techniques for cryptogenic stroke and ESUS.
  • To highlight MRI's role in identifying specific stroke mechanisms and etiologies.
  • To discuss future advancements in MRI for diagnosing cryptogenic stroke and ESUS.

Main Methods:

  • Review of conventional and advanced MRI techniques.
  • Analysis of MRI's utility in detecting differentiating features and stroke patterns.
  • Inclusion of studies examining MRI for identifying causes like atherosclerotic plaques and embolism.

Main Results:

  • MRI can identify differentiating features and stroke patterns in cryptogenic stroke and ESUS.
  • Advanced MRI techniques aid in determining etiologic causes, including atherosclerotic plaques and paradoxical embolism.
  • MRI facilitates the inference of underlying stroke mechanisms.

Conclusions:

  • MRI plays a crucial diagnostic role in evaluating patients with cryptogenic stroke and ESUS.
  • Identifying the stroke etiology through MRI can inform secondary prevention strategies.
  • Technological advancements in MRI are expected to enhance its application in diagnosing cryptogenic stroke and ESUS.

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